Design and Operation of the 2010 National Survey of Residential Care Facilities. APPENDIX XXI: Interviewer Debriefing Questionnaire

11/01/2011

  1. DID THE ADMINISTRATOR HAVE THE PRE-INTERVIEW WORKSHEET FILLED OUT?

    YES
    NO (please explain)

  2. DID RESPONDENT(S) HAVE ANY SPECIFIC DIFFICULTIES ANSWERING ANY QUESTIONS?

    YES
    NO (please explain)

  3. DO YOU FEEL RESPONDENTS WERE ACCURATE IN THEIR ANSWERS?

    YES
    NO (please explain)

  4. WERE THERE ANY QUESTIONS ON THE FACILITY QUESTIONNAIRE WHERE THE RESPONDENT PROVIDED SOME ANSWERS FOR ONLY PART OF THE FACILITY AT THIS LOCATION? THIS MAY OCCUR WHEN THE FACILITY HAS TWO OR MORE LICENSES TO CARE FOR RESIDENTS WITH SIGNIFICANTLY DIFFERENT LEVELS OF DISABILITY, SUCH AS REGULAR ASSISTED LIVING AND ALZHEIMER’S DISEASE CARE.

    YES
    NO (please explain)

  5. PLEASE BRIEFLY DESCRIBE ANY DIFFICULTY THE RESPONDENT HAD ANSWERING THE QUESTIONS.

  6. HOW MANY RESPONDENTS WERE NEEDED TO COMPLETE THE FACILITY QUESTIONNAIRE? PLEASE EXPLAIN WHY MORE THAN ONE RESPONDENT WAS NEEDED.

  7. HOW LONG WERE YOU AT THIS FACILITY, FROM THE TIME YOU ARRIVED UNTIL THE TIME YOU LEFT OR WILL LEAVE?

  8. PLEASE DESCRIBE ANY DIFFICULTY STAFF HAD OBTAINING RESIDENT RECORDS. IF NO DIFFICULTY, ENTER "NONE."

  9. PLEASE DESCRIBE ANY DIFFICULTY STAFF HAD FINDING OR LOCATING INFORMATION WITHIN RESIDENT RECORDS.

  10. PLEASE DESCRIBE ANY DIFFICULTY IN LOCATING THE CORRECT STAFF PERSON TO COMPLETE THE INTERVIEW.

  11. ENTER OTHER COMMENTS ABOUT THIS FACILITY, RESPONDENTS, OR DATA COLLECTED NOT MENTIONED ABOVE. IF NO OTHER COMMENTS, ENTER "NONE."

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